Visual Outcome after Microsurgical removal of Craniopharyngioma via Pterional Craniotomy

Abstract

Background: Craniopharyngioma is a benign tumor of sellar & Suprasellar area with bimodal distribution. Visual disturbance isone of the common clinical presentation. Early surgical intervention results in favourable results.Objective: To analyze visual outcome after surgical removal of craniopharyngioma via pterional craniotomy.Material and Methods: This observational descriptive case series was conducted at department of neurosurgery,LRH/Peshawar. Duration of study was 18 months from Jan 2017 to June 2018. The study included patients withcraniopharyngioma, who underwent surgery in elective setup, newly diagnosed cases and patients operated via pterionalapproach. All those patients who presented in crisis like acute hydrocephalus, operated via other approaches and recurrent caseswere excluded from this study. The changes of visual function (visual acuity and field) of the patients were assessed preoperativelyand postoperatively, documented by a predesigned proforma and paired data of this change were compared. Visual assessmentwas done on follow up visits on 2 weeks,1 month,3 months and 6 months. Chi square test was applied as statistical test. Data wasanalysed through SPSS version 17.Results: Total number of patients were (30) with Male to female ratio was 1.5:1.Age of patients were Ranging from 4 year to 62years (mean 35 years).There were 23 Children (76.6%) and 7 Adults (23.3%).Out of 30 patients, 21 patients(70%) presented withvisual disturbance and 9 patients (30%) had non opthalmogical symptoms. Optic atrophy was seen in 6 patients (20%) preoperatively.Per operatively tumor was found in suprasellar area in 24 patients(80%) and in both supra+infrasellar area in 6patients(20%). Tumor size was less than 3cm in 19 patients(63.3%) and more than 3cm in 11 patients(36.6%). Morphology peroperatively was cystic in 19 patients(63.3%), solid in 5 patients(16.6%) and both solid and cystic in 6 patients(20%). Calcification intumor was seen in 16 patients(53.3%). Gross total resection(GTR) of tumor was done in only 21 patients(70%). Post-operativefollow up assessment of visual status showed that (50%) of patients improved.Conclusion: Craniopharyngioma is a benign tumor with malignant behaviour so timely intervention give favourable results.